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Semantic interoperability of the Electronic Health Record (EHR) has been identified as a key objective of current and future Health Information Systems. But there is often a misunderstanding on what does semantic interoperability really means and requires and, at the same time, a limited view on which advantages it can provide to improve healthcare.

The adoption of appropriate standards for the representation and communication of the information contained at the EHR is only a first step. And a first mistake is to think that only one of them has the perfect solution or can cover all needs for every case of use. The harmonisation and combined use of many health standards is the correct path to success instead of the confrontation between them.

A second requirement is the proper and intensive use of medical terminologies and ontologies. They provide the ideal interface between the daily health care language and a first level of formalisation that will be needed to achieve a complete semantic interoperability. Once again, the solution will not come from the use of a globally unique terminology, but from the correct combination of them all.

Finally, the last and most important requirement is to agree on which the domain concepts that we will use at the health domain are. This agreement, in the form of clinical and technical specifications such as templates, archetypes and detailed clinical models, is a key aspect for semantically interoperable systems, but it has been traditionally left out of the development efforts. Semantic interoperability will not be achieved only by using common syntaxes (standards) and common words (terminologies). It necessarily requires the agreement on the different concepts from the reality that we are going to use in our communication process. And this agreement can only be done with the participation of health professionals and not by technical decisions.

Semantic interoperability has a long-term roadmap that will require many efforts, but the benefits will clearly surpass any expectation. The ability of an information system to automatically share and understand information originated at any other different information system means not only the possibility of achieve a quality continuity of care for patients through the communication of their EHR. It also opens the door to new and exciting possibilities such as the interaction of the EHR with Personal Health Records and a seamless integration of telemedicine systems. Also, the convenient reuse of health information for public health and medicine research will improve the quality of life of people all over the world.